Vascular lasers

What are vascular malformations?

Capillary vascular malformations, also known as telangiectatic naevi are malformed dilated blood vessels in the skin. These lesions are not cancerous, though they seem very serious and appear as blotches of red or purple skin discoloration. The vascular malformations are present at birth and get more prominent over time, and can occur in any part of the body. They can be small dots or sometimes even cover larger areas, growing in proportion to the growth of the body. Some which are called Salmon Patches are mild and generally disappear as the child grows older. Some of them if they are arterial or venous malformations need medical attention as they can interfere with bodily functions. Some like the Portwine stains are difficult to treat and can enlarge with age.

If there is too much of redness on the skin due to dilated blood vessels, especially on the nose, cheeks chin or other parts of the face, they are difficult to control or conceal and must be treated with care. Vascular lesions which occur later in life like Spider veins and thread veins also occur in the areas like cheek, forehead and nose. They are also common in the legs. Telangiectasis/ facial veins, is another disease causing irregular patches of skin in the facial region, often leading to many unacceptable cosmetic effects.

What is the recommended treatment?

Cosmetic dermatologists recommend using lasers to treat these effectively. Traditional treatment methods for the vascular lesions and facial veins included the diathermy and thermolysis systems (electrosurgery). But due to the pain involved in these, laser therapies became more popular. Several variants of laser including the Pulsed Dye Lasers (PDL), Nd:YAG lasers, KTP lasers and Intense Pulsed Light (IPL) systems are used. Many types of facial problems including the facial veins (essential and hereditary telangiectasia), port wine stains, haemangiomas, angiomas, angiokeratoma can be treated effectively using lasers.

How do these lasers work?

The above mentioned diseases are mainly due to two major conditions: the presence of dilated surface blood vessels, or overall increase in blood supply. Both of these result in a flushed appearance, causing red spots to occur. These spots might be smaller or larger depending upon how serious the issue is. Lasers help by the simple principle of photocoagulation

What is the treatment procedure?

Since the laser treatment for the skin is a simple painless procedure, it does not require any special anaesthetic to perform. The momentary hot pulses are compensated by streams of cold air directed at the treated area. This minimizes the mild discomfort some patients might feel with the lasers. In cases of IPL or PDL methods, the skin might look like it is bruised or swollen but they are safe to be hidden by makeup if they so occur.

The lasers work by emitting a wavelength of high energy light that is focused on a certain area of the skin. It creates heat and destroys the targeted cells. The Nd-YAG laser produces two wavelengths at high intensity intervals as short pulses and goes deep into the skin.

While the Nd-YAG laser works by this method, the pulsed dye laser delivers the energy in pulses while a dye is used to generate laser beams of different colours. This laser targets the haemoglobin, the red protein of blood vessels. In both the methods, the skin cells surrounding the dilated blood vessels are not damaged.

Are the lasers safe?

These lasers need special expertise to be operated. Mainly because they target only the particular regions, and are able to reduce the targeted region boundaries to perfectly match with the problem areas, lasers are always one of the safest methods of treatment. They are virtually painless, the discomfort linked to that of temporary bruising and swelling after treatment that goes off in a day or two. Even the heat generated during lasers is compensated with streams of cold air.

What are the after effects?

The lasers can improve the patches but need multiple sessions. While discomfort is minimal, a day’s downtime is enough for people to get back to their routine. No matter what the type of laser, or which veins are being targeted, be it facial veins or the congenital vascular lesions, patients must follow common procedures including avoiding sun exposure. Sun exposure might decrease the efficacy of the procedure and can cause postoperative pigmentation changes. Lasers are capable of removing many types of vascular lesions or veins no matter their size or location with very minimal risk. However, some lesions like the portwine stain may improve but not eradicate.

Other preventive measures like eye shields are also used by dermatologists so there is no risk or damage to the eyes. The effects like scarring, bruising are also discussed beforehand though they are rare. As long as the patient is medically fit and not prone to cold sores or herpes simplex (the viral strains the laser energy might activate), or informs the dermatologists of them beforehand, lasers are the safest to be used on skin.

Dr. Rinky Kapoor (MBBS, DDV, Fellow National Skin Centre, Singapore) is a renowned consultant dermatologist and skin laser expert practicing in Mumbai, India. She is the co founder of The Esthetic Clinic, Mumbai, India, and is a dermato-surgeon expert. She is also an accomplished trichologist.